Esophagogastric tamponade, with balloon (Sengstaken type)
CPT4 code
Name of the Procedure:
Esophagogastric Tamponade, with Balloon (Sengstaken-Blakemore Tube)
Summary
Esophagogastric tamponade with a balloon, also known as a Sengstaken-Blakemore tube procedure, is a medical intervention used to control bleeding in the esophagus or stomach. It involves inflating a specialized balloon within the gastrointestinal tract to apply pressure and stop the bleeding.
Purpose
This procedure is typically used to manage variceal bleeding, which is bleeding from enlarged veins in the esophagus or stomach due to conditions like liver cirrhosis. The goal is to control bleeding and stabilize the patient until more definitive treatment can be provided.
Indications
- Acute esophageal or gastric variceal hemorrhage
- Patients with a history of liver disease or cirrhosis presenting with upper gastrointestinal bleeding
- Not responding to other initial treatments such as medication or endoscopy
Preparation
- The patient may be required to fast (nothing by mouth) for several hours before the procedure.
- Blood tests and imaging studies to assess the patient's condition.
- Intravenous (IV) access for fluids and medications.
- Sedation or anesthesia assessment and preparation.
Procedure Description
- Insertion: The tube, which has two balloons at its end, is inserted through the mouth or nose down into the stomach.
- Balloon Inflation: Once in place, the balloons are inflated. The gastric balloon is inflated first to prevent upward migration; then if needed, the esophageal balloon is inflated to exert pressure on the bleeding varices.
- Pressure Monitoring: The pressure within the balloons is carefully monitored to ensure adequate tamponade without causing tissue damage.
- Stabilization: The tube is secured in place and the patient is closely monitored for bleeding control and overall stability.
Tools: Sengstaken-Blakemore tube, syringe for inflation, pressure gauge. Anesthesia: Sedation or general anesthesia may be used depending on the patient's condition.
Duration
The procedure typically takes about 30-60 minutes but may vary depending on the patient’s situation.
Setting
The procedure is performed in a hospital setting, often in an emergency department, ICU, or operating room.
Personnel
- Gastroenterologist or specialized surgeon
- Nurses
- Anesthesiologist (if sedation or general anesthesia is used)
Risks and Complications
- Balloon rupture
- Esophageal rupture or perforation
- Aspiration pneumonia
- Airway obstruction
- Infection
- Discomfort or pain
Benefits
- Rapid control of life-threatening gastrointestinal bleeding
- Stabilization of the patient for more definitive treatment procedures like endoscopy or surgery
- Provides temporary relief while awaiting further care
Recovery
- Post-procedure monitoring in an ICU or high-dependency unit
- Nutritional support through IV fluids until bleeding is controlled
- Potential need for follow-up endoscopy or surgery
- Continuous monitoring for signs of re-bleeding or complications
Alternatives
- Endoscopic variceal ligation (EVL)
- Endoscopic sclerotherapy
- Transjugular intrahepatic portosystemic shunt (TIPS)
- Medications such as vasopressin or octreotide
- Each alternative has its own benefits and risks, which should be discussed with the healthcare provider.
Patient Experience
During the procedure, the patient may be sedated or under anesthesia, minimizing discomfort. After the procedure, the patient might experience throat discomfort, difficulty swallowing, and a sensation of pressure. Pain management and comfort measures will be provided as needed.